Healthcare Provider Details

I. General information

NPI: 1629099098
Provider Name (Legal Business Name): JANA M BEHRENS PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N MAIN ST
LAS CRUCES NM
88001-1162
US

IV. Provider business mailing address

29863 SW 158TH CT
HOMESTEAD FL
33033
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-0298
  • Fax:
Mailing address:
  • Phone: 305-245-3289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40166
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007077
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: